Healthcare Provider Details

I. General information

NPI: 1669338687
Provider Name (Legal Business Name): BONNIE LEE JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 REDBUD LN
SPRINGFIELD OH
45504-1552
US

IV. Provider business mailing address

1202 REDBUD LN
SPRINGFIELD OH
45504-1552
US

V. Phone/Fax

Practice location:
  • Phone: 937-408-5536
  • Fax:
Mailing address:
  • Phone: 937-408-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: